Healthcare Provider Details

I. General information

NPI: 1235756065
Provider Name (Legal Business Name): 180 URBAN WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 06/27/2020
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 L ST NW STE 500
WASHINGTON DC
20036-4955
US

IV. Provider business mailing address

2001 L ST NW STE 500
WASHINGTON DC
20036-4955
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-2660
  • Fax:
Mailing address:
  • Phone: 202-681-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KELIA MURRAY
Title or Position: OWNER
Credential: LCSW
Phone: 202-681-2660